312 Exam 1 quiz questions
What is Merconium?
Black, tarry, orderless stool passed within 12-14 hrs after birth if this is passed before birth it is a sign of fetal distress
During a home visit to a primiparous client 1 week postpartum who is bottle-feeding her neonate, the client tells the nurse that her mother has suggested that she feed the neonate cereal so he will sleep through the night. What would be the nurse's best response?
"It's better to continue feeding only formula until about 4 to 6 months of age."
After conducting a class for female adolescents about human reproduction, which student statement indicates that the school nurse's teaching has been effective?
"Under ideal conditions, sperm can reach the ovum in 15 to 30 minutes, resulting in pregnancy."
A 20-year-old primigravid client tells the nurse that her mother had a friend who died from hemorrhage about 10 years ago during a vaginal birth. Which response would be most helpful?
"What is it that concerns you about pregnancy, labor, or childbirth?"
What is the functions of the amniotic fluid
-Cushion and protect -controls the embryo's temp -allows freedom of movement for the fetus
When are APGAR scores taken?
1 minute and 5 minutes
What are the normal bilirubin levels in a NB?
1-4 mg/100ml
When is the placenta fully developed?
10 weeks gestation grows wider until week 20
What is the normal HR for a newborn?
10-160 bpm
how many chromosomes does a zygote have?
46
How long can sperm survive?
48-72 hrs Most fertile for only 24 hours
How much weight is it common for a NB to lose?
5-7% of their weight
What is the normal blood glucose levels in a NB?
50-60mg/dl x 3 days 60-70mg/dl after 3 days
When is smell and taste well developed by in a NB?
6 days
Other options for infertility
Adoption
Positive changes
Fetal Heartbeat heard with doppler at about 14-16 weeks as early as 6 weeks via u/s
What does an increase of estrogen cause?
A thickening of the wall of the vaginal mucosa
The one Vein
Carries blood to the embryo
The two arteries
Carry blood from the embryo to the chorionic villi
What is presumptive?
Changes felt by the women
37th to 40 weeks
Considered full term
What is convection?
Cooler air circulating around warmer skin
Treatment considerations
Cost most insurances do not pay for infertility treatments Pregnancy might result in multiple gestation time consuming emotionally or physical draining
How does blood pressure change with pregnancy?
Despite the increase in blood volume, the BP does not usually rise.
When does the umbilical cord start to form?
During the 3rd week after conception, blood vessels begin to develop to supply the embryo with maternal nutrients and oxygen.
What does Hyperthermia cause in NB
Increased metabolic rate & Increases need for glucose & O2
What happens to BP in the second trimester?
It slightly decreases
Term
Normal duration of pregnancy 37-42 weeks
What does the umbilical cord consist of?
One large vein and two small arteries.
What does the thick mucus form?
Operculum (mucus plug)
How are fetal movements found
Palpated by trained examiner after about the 20th week
IgM
Produced by fetus/newborn
IgA
Produced by infant 6-12 weeks after birth
Striae Gravidarum
Stretch Marks
What changes occur to the breasts during pregnancy?
Striae may develop areolas darken nipples become more erectile
What is Wharton's jelly?
Surrounds the vessels of the cord
Gestation
The number of weeks since the first day of the last menstrual period
If the baby is not taking fluids by mouth what should be done to stimulate the sucking reflex?
a pacifier should be offered
Temp and ovulation changes
a ride in temp will occur along the same time as nasal stuffiness
High pitched cries, weak cries & no cries are?
all concerning neurological signs
What causes Goodell's sign?
an increased level of estrogen
How do we take the newborns temp?
axillary
in a NB what is a low body temo more indicative of?
bacteria infection
Conception
beginning of pregnancy single egg and sperm
Initial placenta development begins
begins to form at implantation maternal-placental-embryonic circulation is in place by day 17 -When embryonic heart starts beating
Which partner contributes more to infertility
could be both or one or the other. 35% due to male factor 10-20% we don't know who it's due to.
Probable changes
do not confirm pregnancy Positive pregnancy test
When developing a series of parent classes on fetal development, the nurse should include which feature as being developed by the end of the third month (9 to 12 weeks)?
external genitalia
What is the preembryonic stage?
first 14 days after fertilization Zygote moves through the fallopian tube -takes about 3 days after fertilization
When does Hegar's sign occur?
first trimester
What is conduction
lose heat though direct contact with a cold surface
How does the capacity of the uterus change during pregnancy?
grows from holding 10ml to 1500ml
A dilatation and curettage (D&C) is scheduled for a primigravid client admitted to the hospital at 10 weeks' gestation with abdominal cramping, bright red vaginal spotting, and passage of some of the products of conception. The nurse should assess the client further for the expression of which feeling?
guilt
What is infertility defined as?
inability to achieve conception after 1 year or inability to carry preg to a live birth
What happens with cardiac output?
increases by 30-50% Increases by 10-15 bpm
Stillbirth
infant born dead after 20 weeks gestation
How to prevent convection
maintain room temp at 75 degrees Kangaroo method use cap and swaddle place NB away from drafts or vents
How to prevent conduction
make sure warmer is preheated warm hands and stethoscopes
multipara
more than one birth after 20 weeks gestation
glucosuria
more than trace is abnormal
primipara
one birth at more than 20 weeks gestation
What is secondary infertility
one successful pregnancy but unable to conceive or sustain a 2nd pregnancy
Where does fertilization occur?
outer 3rd of fallopian tube
Weight gain during pregnancy
recommended weight gain 25-35 lbs
What is subfertility?
reduced fertility in both partners
Where can you feel the uterus at 12-14 weeks?
right above the symphysis pubis size of grapefruit
How is the blink reflex tested?
shining a light in eye
What does the trophoblast eventually form?
the chorionic membrane
What does a blastocyst form?
the embryo and amniotic sac
Where can you feel the uterus at 36 weeks gestation?
touches xyphoid process
What level does the bilirubin reach where we start to see it permeate outside the circulatory system into tissues?
6mg/100ml
During a health-teaching session, a pregnant client asks the nurse how soon the fertilized ovum becomes implanted in the endometrium. Which answer should the nurse supply?
7 days after fertilization
NB vision best at
8-12 In
What is the amount of amniotic fluid at more than 20 weeks
800-1200 ml
How long is a full term pregnancy?
9 calendar months 10 lunar months 280 days
What are some male factors that would contribute to infertility?
Abnormal sperm production or function Problems with the delivery of sperm Overexposure to certain environmental factors Damage related to cancer and its treatment
Urine production begins in the 12th week of fetal life and this is the major component of ?
Amniotic Fluid
A nurse observes a family in the playroom. Which behavior would be considered to be an example of social affective play?
An infant is making happy noises in response to her father speaking to her.
Gravida
Any pregnancy, regardless of duration
Para
Birth after 20 weeks regardless of outcome
Abortion
Birth that occurs before the 20th week of gestation Can also refer to the termination of pregnancy
What is a Cephalohematoma?
Blood between skull bone and periosteum Caused by pressure on maternal pelvis or birth trauma resolves in 3-6 weeks increased risk if hyperbiliruninemia
What can be reliable in a NB to tell if their have an infection?
CBC
What happens during implantation?
Cells float freely in the uterus Trophoblast attaches itself to the surface of the endometrium for nourishment of the blastocyst Normally implants on the upper posterior wall of the uterus -called the fundal region or the fundus
How is the rooting reflex tested?
Cheek is stroked near corner of mouth
What is brown fat more rapidly depleted by?
Cold Stress
What is there a large amount of in the first 3 days of the NBs life?
Dilute urine
How to prevent evaporation?
Dry NB remove wet linens Keep dry during bath
What important steps should nurse take to keep baby warm immediately after birth?
Dry and wrap in warm blanket Cover head with hat Place NB under radiant heat source or place NB on mom's abdomen
Chorionic Gonadotropin(hCG)
Earliest biochemical marker for pregnancy.
Which recommendation would be the most appropriate preventive measure to suggest to a primigravid client at 30 weeks' gestation who is experiencing occasional heartburn?
Eat smaller and more frequent meals during the day.
What is Caput Succedaneum
Edema of the scalp from pressure during birth disappears within 3-4 days
Using Naegele's rule for a client whose last normal menstrual period began on May 10, the nurse determines that the client's estimated date of birth is what date?
February 17
What is the chorion?
First membrane to form around the embryo surrounds the amnion, the embryo
How much does the uterus grow?
From 60 grams to 1100 grams
24th Weeks
Grasp reflex is present Startle reflex present Tells us CNS is working well footprints present Vernix caseosa alveoli are starting to form
What do we assess for apgar?
HR, RR, muscle tone, reflex irritability and color Normal score 8-9 10 is perfect and not very common
A client calls to schedule a pregnancy test. The nurse knows that most pregnancy tests measure which hormone?
Human chorionic gonadotropin (hCG)
What would cause higher than normal hCG levels?
Hydatidiform Mole (molar) pregnancy Ectopic pregnancy abnormal gestation (down syndrome) Multiple gestation
SGA and LGA babies tend to be prone to
Hypoglycemia
A pregnant client is seeking information from the nurse about a home birth with registered midwives. Which of the following statements lets the nurse know that the client has considered the risks and benefits of using a midwife? Select all that apply.
I will develop a list of questions to use in interviewing potential midwives." "I realize that I may need to be transferred to a hospital if complications develop." "I understand the complications that could occur in a home birth setting."
During an annual checkup, a client tells the nurse that she and her partner have decided to start a family. Ideally, when should the nurse plan for childbirth education to begin and end?
It should begin before conception and end 3 months after childbirth.
What are increased vaginal secretions called?
Leukorrhea
What is the purpose of the operculum?
Mucus plug forms a protective barrier for the fetus.
The nurse is assessing a 16-year-old nulligravida, who asks for information on natural family planning methods of contraception and reports that her menstrual cycle occurs every 28 days. Which information would be important to include in the teaching plan for this client?
Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle.
What are some female factors that contribute to infertility?
Ovulation, cervical or uterine abnormalities Fallopian tube blocked endometriosis pelvic adhesions cancer
IgG
Passive immunity from mom
How does the cardiovascular system change during pregnancy?
Physiologic Anemia of pregnancy -plasma increases more than erythrocytes -H&H will decrease by 7% when looking at serum level Due to hemodilution
How to prevent radiation
Place cold objects away from NB
The nurse plans care for a neonate to prevent neonatal heat loss immediately after birth. What action should the nurse take to conserve heat and help the infant maintain a stable temperature?
Place the infant skin to skin with the mother.
What is Goodell's sign?
Softening of the cervix
What is Hegar's sign?
Softening of the isthmus of the uterus -area between the cervix and the body of the uterus. -feels as thin as tissue paper.
Bright green stools
Stools from babies undergoing phototherapy
A multigravid client who stands for long periods while working in a factory visits the prenatal clinic at 35 weeks' gestation, stating, "The varicose veins in my legs have really been bothering me lately." Which instruction would be most helpful?
Take frequent rest periods with the legs elevated above the hips.
What does the umbilical vein do?
Takes oxygenated blood back to the fetus
What do the umbilical arteries do?
Takes un-oxygenated blood from the fetus to the villi to become oxygenated
What is the moro reflex?
The startle reflex
What happen to the umbilical vein and arteries after birth?
They're converted to ligaments
A pregnant client in her third trimester asks why she needs to urinate frequently again, as she did during the first trimester. What should the nurse tell her?
This symptom is normal and results from the fetus exerting pressure on the bladder.
What are Braxton Hicks contractions?
Uterine contractions
The nurse is developing a community health education program about sexually transmitted infections. Which information about women who acquire gonorrhea should be included?
Women with gonorrhea are usually asymptomatic.
A client, 11 weeks pregnant, is admitted to the facility with hyperemesis gravidarum. The client tells the nurse she has never known anyone who had such severe morning sickness. The nurse understands that hyperemesis gravidarum results from:
an unknown cause.
How early can hCG be detected?
as early as 7-10 days after conception
Kangaroo care is as good as
as good as if the NB is under a heater.
A nurse is assessing the legs of a client who's 36 weeks pregnant. Which finding should the nurse expect?
bilateral dependent edema
A nurse is caring for a client in the first 4 weeks of pregnancy. The nurse should expect to collect which assessment findings?
breast sensitivity
A primiparous woman has just given birth to a term infant. What topic should the nurse teach the client about first?
breastfeeding
NB stool
by 5th or 6th day depends in type of feeding
multigravida
in her second or subsequent pregnancy
nulligravida
never been pregnant
nullipara
no births after 20 weeks gestation
Mucus stools
suspect a milk allergy
A client in the first trimester of pregnancy joins a childbirth education class. During this trimester, the class is most likely to cover which physiologic aspect of pregnancy?
warning signs of complications
A pregnant client at about 29 weeks' gestation asks the nurse "What can I do about this dark brown line running down my stomach?" When teaching the client about this brown line, what should the nurse tell the client?
"This is a linea nigra that will fade after the baby is born."
What is Incidence of infertility ?
10-15% of couples in the US are diagnosed with infertility not all will seek treatment
Fetus begins to secrete his/her own insulin at?
12-14 weeks
How does uterine blood flow change during pregnancy?
15-20 ml/min to 500-750 ml/min
Weight gain during pregnancy for overweight pt
15-25 lbs
What is the max volume of VIT K that can be safely given IM to a NB?
1Ml
What is the size of the umbilical cord?
2 cm across 55 cm long Implants normally on the center of the placenta.
The NB should have their first void by?
24 hrs
During routine preconception counseling, a client asks how early a pregnancy can be diagnosed. What is the nurse's best response?
"8 days after conception."
Which statements made by a pregnant woman in the first trimester are consistent with this stage of pregnancy? Select all that apply.
"I wonder how it will feel to buy maternity clothes and be fat." "My husband told his friends we'll have to give up the convertible for a minivan." "Oh my, how did this happen? I don't need this now."
What is a zygote?
True moment of fertilization when sperm and ovum unite 23 chromosomes from each zygote
How does the cervix change during pregnancy?
Increased levels of estrogen Stimulates the glandular tissue of the cervix to secrete a thick mucus
What is the amnion?
Thin protective membrane that contains amniotic fluid. as the fetus grows, the two membranes form one- Amniotic sac
Which statement by the nurse would be most appropriate when responding to a primigravid client who asks, "What should I do about this brown discoloration across my nose and cheeks?"
"This usually disappears after birth."
Once ovum is released how long is it fertile for?
24 hours after ovulation
Which chromosome determines the gender characteristics?
23rd Female XX Male XY
How long does it take for the newborn's temp to stabilize after birth?
24 hours
What is transitional stool?
3-4th day greenish loose
What is the amount of amniotic fluid at 10 weeks?
30 ml
What is the amount of amniotic fluid at 20 weeks?
350 ml
Lungs will fully mature at
36 weeks
What is a normal NB WBC count?
9,000-30,000 avg (17,000)
Core body temps less than _______ have been correlated with poor brain growth and increased mortality
97.5 degrees F
What is a normal newborns temp
97.7-100
What is one of the first signs of pregnancy?
Breasts enlarge (about 6 weeks)
How early does the beta subunit of hCG begin?
Can begin as early as the day of implantation
What is Viability?
Capacity to live outside the uterus 22-24 weeks Fetal weight more than 500grams
What is a blastocyst?
Inner solid mass of cells
Management for infertility
Intrauterine insemination In Virtro Fertilization-embryo transfer (IVF) -Can use donor sperm or eggs
What is the amniotic fluid?
This is formed by diffusion from the maternal blood. The fetus swallows fluid, then urinates into the fluid, increasing the volume.
What is side A of the placenta called?
Maternal side A Duncan "Dirty Duncan"
What will help newborns take their first breath?
Mechanical factor- Pressure on chest causes "Passive Respiration" Sensory Stimuli- touch, warm, cold environment, noise/sounds, lights Chemical- decreased O2 and pH increased PCO2 which leads to transitory asphyxia which will cause them to take their first breath.
How to improve infertility prior to diagnosis
Meet psychosocial needs (REDUCE STRESS) Lifestyle change (including nutrition) Teach how to maximize fertilization
A primigravid client attending parenthood classes tells the nurse that there is a history of twins in her family. What should the nurse tell the client?
Monozygotic twins occur by chance regardless of race or heredity.
black or tarry stool
suspect intestinal bleeding
A primigravid client at 36 weeks' gestation tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which suggestion would be most helpful?
Practice relaxation techniques before bedtime.
A nurse is developing a teaching plan for a primigravid client who's 2 months pregnant. The nurse should tell the client that fetal movement can be felt beginning at which time?
between 18 and 20 weeks' gestation
What are the characteristics of bottle-feeding babies
by 4th day pale yellow-light brown stools firmer consistency more odorous sour milk odor approx two stools per day
When is colostrum present?
during he 2nd and 3rd trimester possibly as early as the 16th week Gradually converts to mature milk within the first few days after childbirth
When do developmental disorders typically occur
during sensitive time frames
When is Chadwick's sign noticeable?
during the first 3 months
When is the most crucial time period ?
during the first 3 months
What can abnormally slow increase or decrease of hCGs indicate?
impending miscarriage
Postterm or postterm labor
labor that occurs after 42 weeks
What are some factors that effect heat loss in NB
little subcue fat blood vessels closer to skin they rarely shiver
What is a trophoblast?
outer layers of cells
supine hypotensive syndrome will reduce blood flow to the
placenta so avoid laying supine!
What is Brick Dust?
precipitated urate crystals not uncommon in the first 2 days if life
primigravida
pregnant for the first time
When do Braxton Hicks contractions occur?
start after the 4th month of pregnancy
Why might the WBC count be increased in NB?
the stress of labor NOT due to the infectious process
How is Hegar's sign revealed?
through a bimanual exam
Weight gain for underweight pts during pregnancy
weight needs to reach their ideal weight plus 25-35 lbs
The health care provider (HCP) prescribes an intramuscular injection of vitamin K for a term neonate. The nurse explains to the mother that this medication is used to prevent which problem?
hemorrhage
When instilling erythromycin ointment into the eyes of a neonate 1 hour old, the nurse would explain to the parents that the medication is used to prevent which problem?
blindness secondary to gonorrhea
The client gives birth to a neonate who is given a score of 9 at 5 minutes on the Apgar rating system. How does the nurse interpret the neonate's physical condition?
good
A newly pregnant client tells the nurse that she hasn't been taking her prenatal vitamins because they make her nauseated. In addition to telling the client how important taking the vitamins are, the nurse should advise her to:
take the vitamin on a full stomach.
A nurse is doing an assessment of a pregnant client who states that she smokes one pack of cigarettes each day. The nurse should:
inform the client of the risks to the fetus and ask if she'd like a referral to a smoking cessation support group.
A client who tells the nurse that she would like to use the basal body temperature method for family planning receives instructions about the method. Which client statement indicates to the nurse that the teaching has been successful?
"It's important to take my temperature at about the same time every morning before arising."
A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which client statement about IVF indicates that the client understands this procedure?
"IVF involves bypassing the blocked or absent fallopian tubes."
After instructing a primigravid client about desired weight gain during pregnancy, the nurse determines that the teaching has been successful when the client states which statement?
"Although it varies, a gain of 25 to 35 lb (11.4 to 14.5 kg) is about average."
A nurse demonstrates infant bathing to a primiparous client. Which statement by the client indicates a need for additional teaching?
"I have all kinds of pretty, scented soaps and lotions to bathe the baby with."
A nurse is teaching a client who gave birth to a full-term female neonate how to change the neonate's diaper. Which of the following statement by the client would indicate to the nurse that learning has taken place?
"I will clean and dry the neonate's perineal area from front to back."
The father of a neonate scheduled for gastrointestinal surgery asks the nurse how newborns respond to painful stimuli. What is the nurse's best response?
"Newborns typically move their whole body in response to pain."
A nurse is providing care for a pregnant 16-year-old. The client says that she is concerned she may gain too much weight and wants to start dieting. The nurse should respond by saying:
"Nutrition is important because depriving your baby of nutrients can cause developmental and growth problems."
A nurse is administering vitamin K to a neonate following birth. The medication comes in a concentration of 2 mg/ml, and the ordered dose is 0.5 mg to be given subcutaneously. How many milliliters would the nurse administer? Record your answer using two decimal places.
.25
The newborn nurse has just received shift report about a group of newborns and is to receive another admission in 30 minutes. In order to provide the safest care and plan for the new admission, the nurse should do which tasks in order of first to last? All options must be used.
1. Review notes from shift report, and prioritize all clients; make rounds on the most critical first. 2.Move quickly from room to room, and assess all clients. 3.Log on to the clinical information system, and determine if there are new orders. 4.Check the room to which the new client will be admitted to ensure all supplies and equipment are available.
tightening sensation over her pubic bone every 15 minutes. She reports no vaginal fluid leakage. Because she has just entered her 36th week of pregnancy, she is apprehensive about her symptoms. Vaginal examination discloses a closed, thick, posterior cervix. These findings suggest that the client is experiencing:
Braxton Hicks contractions.
While assisting a primiparous client with her first breastfeeding session, the nurse should instruct the mother to perform which action in order to stimulate the neonate to open the mouth and grasp the nipple?
Brush the neonate's lips lightly with the nipple.
While assessing a multigravid client at 10 weeks' gestation, the nurse notes a purplish color to the vagina and cervix. The nurse documents this as what finding?
Chadwick's sign
A couple visiting the infertility clinic for the first time states that they have been trying to conceive for the past 2 years without success. After a history and physical examination of both partners, what would be the most appropriate outcome for the couple to accomplish by the end of this visit?
Describe each of the potential causes and possible treatment modalities.
What information should the nurse include in a teaching plan for first-time parents of a bottle-feeding term newborn? Select all that apply.
Do not prop the bottle. Fill the entire nipple of the bottle with formula. The husband can feed the baby the bottle whenever possible.
A client is planning to be treated for infertility with the zygote intrafallopian transfer (ZIFT) method. Which information should the nurse include when teaching the client about this type of treatment method?
Fertilization takes place outside of the body.
After instructing a female client about the radioimmunoassay pregnancy test, the nurse determines that the client understands the instructions when the client states that which hormone is evaluated by this test?
human chorionic gonadotropin (hCG)
A nurse is performing a physical examination of a primigravid client who's 8 weeks pregnant. At this time, the nurse expects to assess:
Hegar's sign.
Which client statement indicates a need for additional teaching about self-care during pregnancy?
I should sit in a hot tub for 20 minutes to relax after working."
A full-term neonate is admitted to the normal newborn nursery. When lifting the baby out of the crib the nurse notes the baby's arms move sideways with the palms up and the thumbs flexed. What should the nurse do next?
Identify this reflex as a normal finding.
While preparing to provide neonatal care instructions to a primiparous client who gave birth to a term neonate 24 hours ago, what should the nurse include in the client's teaching plan?
Milia are white papules from plugged sebaceous ducts that disappear by age 2 to 4 weeks.
Which of the following should the nurse use to determine achievement of the expected outcome for an infant with severe diarrhea and a nursing diagnosis of Deficient fluid volume related to passage of profuse amounts of watery diarrhea?
Moist mucous membranes.
A client comes to the office for her first prenatal visit. She reports that January 3 was the first day of her last menstrual period. According to Naegele's rule, what date should the nurse record as the estimated date of delivery (EDD)?
October 10
A client's prenatal record shows a gravida 2, para 0111. From this information, the nurse knows that the client has been pregnant twice. What else does this information reveal about the client's obstetric history?
One pregnancy resulted in an abortion and one resulted in a preterm neonate who's living.
When teaching a group of pregnant adolescent clients about reproduction and conception, the nurse is correct when stating that fertilization occurs:
in the first third of the fallopian tube.
Which statement describes the rationale for administering vitamin K to every neonate?
The neonate lacks intestinal flora to make the vitamin.
At 24 hours of age, assessment of the neonate reveals the following: eyes closed, skin pink, no sign of eye movements, heart rate of 120 bpm, and respiratory rate of 35 breaths/min. What is this neonate most likely experiencing?
a state of deep sleep
When performing a physical assessment on a postterm neonate, the nurse expects to find
abundant subcutaneous fat.
The nurse conducts the health assessment of a client who is a primigravida in the prenatal clinic. Which presumptive signs of pregnancy should the nurse expect to assess?
amenorrhea and quickening
A primiparous client with a neonate who is 36 hours old asks the nurse, "Why does my baby spit up a small amount of formula after feeding?" The nurse explains that the regurgitation is thought to result from which factor?
an immature cardiac sphincter
A client diagnosed with testicular cancer expresses concerns about fertility. The client and his spouse desire to eventually have a family, and the nurse discusses the option of sperm banking. What should the nurse tell the couple about the best time to donate the sperm?
before treatment is started
When measuring the fundal height of a primigravid client at 20 weeks' gestation, the nurse will locate the fundal height at which point?
at about the level of the client's umbilicus
A client with human papillomavirus (HPV) infection is being treated by a colposcopy. The client asks the nurse if this procedure is really necessary. The nurse can tell the client that if the HPV infection is not treated which health problem is likely to occur?
cervical cancer
A 25-year-old client tells the nurse that she would like to become pregnant, but she has been diagnosed with blocked fallopian tubes due to pelvic inflammatory disease. When helping the client explore infertility treatment options, what is most appropriate for this client?
in vitro fertilization
A male client has been diagnosed as having a low sperm count during infertility studies. After giving instructions about causes of low sperm counts, the nurse determines that the client needs further instructions when the client says low sperm counts may be caused by which health problem?
decreased body temperature
A nulliparous client says that she and her husband plan to use a diaphragm with spermicide to prevent conception. Which should the nurse include as the action of spermicides when teaching the client?
destruction of spermatozoa before they enter the cervix
A nulliparous client tells the nurse that during her last pelvic examination, the health care provider said that her uterus was in a severe retroverted position. The nurse determines that the client may experience which complication?
difficulty conceiving a child
At which time should the nurse anticipate assisting a client to breastfeed her neonate?
during the neonate's first period of reactivity
An infant diagnosed with Hirschsprung's disease is scheduled to receive a temporary colostomy. When the nurse is initially discussing the diagnosis and treatment with the parents, which action by the nurse would be most appropriate?
encouraging them to ask questions
Which findings are considered positive signs of pregnancy?
fetal heartbeat and fetal movement on palpation
A nursery nurse just received the shift report. Which neonate should the nurse assess first?
four-hour-old term neonate with jaundice
A pregnant client complains of nausea every morning and again before meals. As a result of the nausea, the client has been unable to eat enough and has lost weight. Which nonpharmacologic intervention should the nurse recommend?
keeping crackers at the bedside to eat before getting out of bed
A client is in the eighth month of pregnancy. To enhance cardiac output and renal function, the nurse should advise the client to use which body position?
left lateral
After trying for a year to conceive, a couple consults an infertility specialist. When obtaining a history from the husband, the nurse asks about childhood infectious diseases. Which childhood infectious disease most significantly affects male fertility?
mumps
A female client with infertility related to anovulatory cycles is prescribed menotropins. The nurse should assess the client for which possible adverse effect of this medication?
ovarian enlargement
After completing discharge instructions for a primiparous client who is bottle-feeding her term neonate, the nurse determines that the mother understands the instructions when the mother says that she should contact the pediatrician if the neonate exhibits which sign or symptom?
passage of a liquid stool with a watery ring
A primiparous client who is beginning to breastfeed her neonate asks the nurse, "Is it important for my baby to get colostrum?" When instructing the client, the nurse would explain that colostrum provides the neonate with which factor?
passive immunity from maternal antibodies
A 30-year-old multigravid client has missed three periods and now visits the prenatal clinic because she assumes she is pregnant. She is experiencing enlargement of her abdomen, a positive pregnancy test, and changes in the pigmentation on her face and abdomen. These assessment findings reflect this woman is experiencing a cluster of which signs of pregnancy?
probable
A 15-year-old primigravid client at approximately 16 weeks' gestation tells the nurse that she has been experiencing an occasional sharp pain from the fundus to her pubic bone on the left side. The nurse determines that the client is most likely experiencing which complication?
round ligament pain
A primigravid client visits the clinic at 12 weeks' gestation and tells the nurse that she has a cold and her nose is stuffy. The nurse should instruct the client to treat the nasal stuffiness by using which approach?
saline nose drops
A client has been trying to achieve a pregnancy for 3 years and has just recently sought the assistance of an infertility specialist. Which tests may be conducted to analyze the causes of this client's infertility? Select all that apply.
semen analysis hysterosalpingogram basal body temperature graph hypothalamic pituitary levels
A couple is visiting the clinic because they have been unable to conceive a baby after 3 years of frequent coitus. The nurse determines that the couple needs further instruction when they identify which factor as a cause of male infertility?
seminal fluid with an alkaline pH
A breastfeeding primiparous client who gave birth 8 hours ago asks the nurse, "How will I know that my baby is getting enough to eat?" Which guideline should the nurse include in the teaching plan as evidence of adequate intake?
six to eight wet diapers by the fifth day
The parents of a child with colic are asked to describe the infant's bowel movements. Which description should the nurse expect?
soft, yellow stools
Which observation is expected when the nurse is assessing the gestational age of a neonate born at term?
sole creases covering the entire foot
The nurse in a postpartum couplet room is making rounds prior to ending the shift. Which findings indicate that the safety needs of the clients have been met? Select all that apply.
someone in room able to care for infant identification system on mother and infant bulb syringe within sight security tags in place
A nurse is teaching a female client, who is positive for human immunodeficiency virus, about pregnancy. The nurse should know more teaching is necessary when the client says:
"I'll need to have a cesarean birth if I become pregnant and have a baby."
While changing the neonate's diaper, the client asks the nurse about some red-tinged drainage from the neonate's vagina. Which response would be most appropriate?
"Sometimes baby girls have this from hormones received from the mother."
A newly hired nurse on unit orientation prepares to administer vitamin K to a neonate. The nurse draws up 1 mg of vitamin K and prepares to administer a subcutaneous injection in the left, lateral anterior thigh. Which action by the nurse preceptor is best?
Stop the nurse and ask that the injection techniques be reevaluated.
A client is seeking infertility treatment after attempting pregnancy for 2 years. Of the following data from the client's history, which has the greatest impact on infertility?
The client is a gymnast weighing 105 lb (47.6 kg).
A client and her partner, both 25 years old, are having trouble conceiving. Infertility in this couple is defined as:
the inability to conceive after 1 year of unprotected attempts.
A client has undergone a vasectomy. The nurse instructs the client that he can begin having unprotected intercourse at what time following the surgery?
when the sperm count reflects sterilization
When assessing a postterm neonate, what is considered a normal finding?
wrinkled, peeling skin
Any NB temp lower than _____ or higher than _____ is concerning and should be reported!
More than 99 and less than 97.9
Fetal Stage 20 week
Mother feels quickening by this stage and we can determine gender at this stage. Lanugo is covering the entire body especially shoulders Increase in brown fat
A primigravida at 8 weeks' gestation tells the nurse that she wants an amniocentesis because there is a history of hemophilia A in her family. The nurse informs the client that she will need to wait until she is at 15 weeks' gestation for the amniocentesis. Which is the most appropriate rationale for the nurse's statement regarding amniocentesis at 15 weeks' gestation?
The volume of amniotic fluid needed for testing will be available by 15 weeks.
How do Braxton Hicks contractions differ from traditional contractions?
They do not cause cervical changes and they do not increase in intensity or frequency
What is positive?
Those that can be attributed only to the presence of a fetus
How does a NB lose heat through evaporation?
Through wet skin
Antepartum
Time between conception and the onset of labor. Also called "Prenatal"
Postpartum
Time from birth of placenta until the woman's body returns to ore-pregnant condition
Intrapartum
Time from the onset of true labor until the birth f the placenta
Newborn circulatory are totally
Transformed or changed with adequate respiratory function
Dizygotic twins
Two separate ova fertilized by two separate sperm Increased likely hood if gonadotropin levels are higher Two placentas two amniotic sacs Fraternal
Conception occurs
Typically occurs 2 weeks after the first day of the LMP
Further Assessment methods for female infertility
Vaginal Ultrasound endometrial biopsy Hysterosalpingogram (HSG) Hysteroscopy Lapatoscopy
What is the site that is used for VIT K injection?
Vastus lateralis
What is Chadwick's sign?
Violet or Bluish discoloration of the vaginal mucous membrane and cervix due to increased vascularity
During a visit to the clinic, a mother who's breast-feeding her 2-month-old infant expresses concern over the infant's bowel movements. Which statement by the mother would lead the nurse to believe that the infant's bowel movements are normal?
"The baby's stools are bright yellow and soft."
While the nurse is conducting a teaching session on breast-feeding, a client asks why she should put her newborn to the breast within the first 30 minutes of birth. The nurse's best response will be
"The neonate will be responsive and eager to suck at this time."
The parents of a child with sickle cell disease ask the nurse why their child's hemoglobin was normal at birth but now the child has S hemoglobin. Which response by the nurse is appropriate?
"The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."
According to the antenatal record, a newborn is 12 days post-mature. A nurse completes the initial assessment of the newborn and notes increased amounts of vernix. The mother asks why the nurse seems concerned about the presence of the vernix. Which of the following statements by the nurse is most appropriate?
"The vernix indicates a different gestational age than expected."
A pregnant client is experiencing a thin, odorless, vaginal discharge. What should the nurse instruct the client to do to prevent vaginal infections?
"Try wearing a panty liner and discarding it after every urination."
The nurse is preparing to administer vitamin K intramuscularly to a term neonate of a primipara who has just given birth. After explaining the purpose of the drug to the mother, which statement by the mother indicates effective teaching?
"Vitamin K will help my baby's blood to clot properly."
What is a normal newborn RR?
30-60 RR per min
How many ml will the NB stomach hold when stretched?
30-90ML
When does lightning occur?
38-40 weeks gestation Height drops as the fetus settles into the pelvis
How do we diagnose infertility
First approach - easiest and least intrusive -semen analysis -extensive interview -physical examination of both male and female -lab tests
What are the characteristics of breast fed babies?
By the 4th day light yellow, golden stool seedy sweet smelling 3-4 stools per day
viability
Capacity to live outside the uterus about 22-24 weeks gestation Fetal Weight more than 500 grams
What is probable?
Changes observed by an examiner
What is the nurses role in fertility treatment?
Counselor Educator Advocate
Closure of the
Ductus Venosus Ductus arteriosus
When is goodells sign noticeable?
During the first three months
What is side B of the placenta called?
Fetal side B Shiny called "Schultz" Shiny Shultz
What is not a reliable sign of infection in a NB?
Fever
What is the function of the placenta?
Metabolic and nutrient exchange between mom & baby
What happens to the newborns temp after birth?
It drops drastically
When is the first trimester of pregnancy?
LMP through week 13
Preterm or premature labor
Labor that occurs after 20 weeks but before 37 weeks
What are the considerations for adoption?
Long waiting periods continual setbacks high costs
29th to 32nd week
Lungs still not fully mature!
A NBs cry should be
Lusty & vigorous
What happens with the respiratory system when pregnant
Nasal stuffiness or congestion due to increase in estrogen
How are the signs of pregnancy categorized?
Presumptive Probable Positive
What does the umbilical cord supply?
Provides a circulatory pathway to nourish the embryo
What happens during the fetal stage?
Refinement and perfection of the different structures
What are some effects of cold stress or hypothermia in NB?
Respiratory distress Hypoglycemia loss of weight or failure to gain increased jaundice
Nurse's responsibility to understand and facilitate this extrauterine adaptation
Respiratory system Circulatory system Ability to Termoregulate Ability to procure a source of glucose
what happens with aldosterone during pregnancy?
Results in an increase in reabsorption of salt and water
Which instructions should the nurse include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning?
Severe cramping may occur when the IUD is inserted.
What are some discomforts in the 3rd trimester?
Shortness of breath insomnia mood swings increased urinary frequency and urgency
Monozygotic
Single fertilized ovum, single sperm Single zygote Zygote divides completely into two Same sex, same genotype
Uterine souffle
Sound made by blood in the uterine arteries Synchronous with the maternal heart rate
Funic Souffle
Sound made by blood rushing through the umbilical vessels
What is ballottement?
Technique of palpating a floating structure by bouncing it gently and feeling it rebound
When is the 2nd trimester?
Week 14 through 26
When is the 3rd trimester?
Week 27-40
When is the embryonic stage?
Week 3-8 3 cm long at the end of week 8 Most susceptible to teratogens during this stage
How does a NB lose heat through radiation?
When heat radiates near a cooler surface like a draft from a window or AC
When will difficulty breathing get better?
When lightning occurs
What is supine hypotensive syndrome?
enlarged uterus may press against the vena cava and aorta. Reduces blood flow to the right atrium which lowers BP and causes dizziness.
A client who's 12 weeks pregnant attends a class on fetal development as part of a childbirth education program. The nurse anticipates that at 16 weeks' gestation, the client's fetus will:
have audible heart sounds.
The nurse is witnessing the client's signature on the informed surgical consent for an abdominal hysterectomy. The nurse should be certain the client understands that what will be the outcome of this surgery?
infertility.
What happens to the gastrointestinal system during pregnancy?
nausea and vomiting typically occurs from 4-12 weeks Delayed gastric emptying time and peristalsis due to smooth muscle relaxation from elevated progesterone levels -results in bloating and constipation
A mother is instructed to stimulate the rooting reflex when attempting to breast-feed her baby. Which action shows that the mother understands these instructions?
stroking the neonate's cheek
Clay colored gray stools
suspect an obstructed bile duct as the stool is lacking pigment
After instructing a primigravid client about the functions of the placenta, the nurse determines that the client needs additional teaching when she says that which hormone is produced by the placenta?
testosterone
When can lightning be felt for mom?
usually about 2 weeks before the term for primapara time
Where can you feel the uterus at 20-24 weeks gestation?
uterus is about the level of umbilicus
How do you visualize the fetus?
via ultrasound as early as 5-6 weeks to detect fetal parts
